Smartphone App Reduces Cancer-Pain Severity and Pain-Related Hospital Admissions
NEW YORK (Reuters Health) - Use of an artificial intelligence (AI)-based smartphone app can help reduce the severity of cancer pain and related hospital admissions, according to a new study.
The findings were presented November 16 at the 2018 Palliative and Supportive Care in Oncology Symposium in San Diego, California.
"The vast majority of people with cancer experience pain at some point, and we need better tools to track and report it. My hope is that these findings will pave the way for more widespread use of apps among patients who are experiencing pain, so that they can get the support they need," Dr. Joshua Adam Jones, chair of the symposium news planning team and not linked to the study, said in a conference news release.
The app, called ePAL, was designed in collaboration with Partners HealthCare Pivot Labs and Massachusetts General Hospital in Boston. The app sends alerts to a smartphone with daily pain management tips and encourages users to record their pain levels three times a week. The AI in the app can distinguish urgent from non-urgent pain and provides appropriate patient education in real time. If cancer pain is severe or worsening, the app connects patients to a nurse who responds within an hour.
Dr. Mihir Kamdar, associate director of palliative care at MGH, and colleagues studied the app in 112 adults with stage IV solid cancer and moderate to severe pain from the MGH Palliative Care Clinic; half were randomly assigned to use the app in addition to usual care for eight weeks and half to usual care only (control group).
At enrollment, average pain scores on the Brief Pain Inventory (BPI) were similar in the two groups. At the end of eight weeks, BPI pain severity scores in app users had dropped by around 20% (from 3.74 out of 10 at enrollment to 2.99 at eight weeks), with no change in pain score in the usual care group (4.02 at enrollment and 4.05 at eight weeks).
During the study, ePAL users had fewer pain-related inpatient hospital admissions compared to non-users (four vs. 20). "We saw about a 69% per-patient relative risk reduction in being admitted for pain over the course of the two-month study compared to the control group," Dr. Kamdar noted in a phone interview with Reuters Health.
"It's significant that patients who used the app had significantly fewer hospital admissions without an associated increase in outpatient clinical burden," Dr. Kamal Jethwani, senior director of Pivot Labs at Partners Healthcare, who worked on the study, added in the news release. "These findings suggest that integrating innovations like mobile technology and AI could have a real impact on patient well-being, resource utilization, and cost of care."
Patients using the ePAL app had an increase in anxiety scores (6.67 to 7.68 out of 21). The researchers think that simply asking about pain may induce anxiety in some people. However, people reporting pain via the app more than twice a week did not experience an increase in anxiety.
Dr. Kamdar said there was some concern that the app would increase call burden among providers, "but we were pleasantly surprised to see that that wasn't the case. The app only triggered a call over the two months about one time for every two patients. That suggests that there is actually a lot that the app is able to handle itself."
Going forward, the researchers plan to build a more robust and innovative next generation ePAL app and study it in other clinical settings.
"We're especially interested to see if this type of novel technology can be helpful in areas where access to palliative care is limited. Our hope is to use innovation and technology to extend the reach of palliative care to those who need it most," Dr. Kamdar said in the release.
The study was funded by a grant from the McKesson Foundation. Dr. Kamdar has disclosed a financial relationship with Amorsa Therapeutics.
2018 Palliative and Supportive Care in Oncology Symposium.